Credit Application

List Corporate Officers, Partners, or Owners: Name/Title/Address/Social
CorporationPartnershipProprietorshipOther

Have you ever filed for bankruptcy?
YesNo

Sales Tax Exempt?
YesNo

Purchase Order No. Required?
YesNo

The Undersigned agrees to pay promptly when due all invoices representing purchases on credit pursuant to this application, including applicable late charges, if any. All accounts are payable at Seller’s offices and shall be paid to Seller at mailing address as shown on Seller’s invoice. Default in payment shall entitle Seller to recover it’s collection cost, reasonable attorney’s fees and interest, or at its option, to recover the merchandise without liability of any kind and will give Seller cause to terminate further rentals on an open account basis.